Knowledge and Use of Silver Diamine Fluoride by Dentists in Libya: A Cross-Sectional Study

Abstract

Silver diamine fluoride (SDF) is a minimally invasive cariostatic solution recommended by leading pediatric dentistry organizations; however, its uptake in dental practice differs across countries. To date, no nationally representative study has examined Libyan dentists’ knowledge, attitudes, and practices regarding SDF. This study was conducted to assess awareness, knowledge, attitudes, clinical use, and perceived barriers towards SDF among Libyan dentists. A cross-sectional study was conducted from July 2025 to May 2026 among 527 Libyan dentists across multiple governorates using a validated electronic questionnaire. Data was analyzed using SPSS V 27. Descriptive statistics summarized responses; chi-square tests examined associations between demographic variables and history of SDF use. A composite overall Knowledge Score (OKS) was constructed from ten binary items. Overall, 81.8% of respondents were aware of SDF, predominantly through colleagues (28.8%) and online resources (28.1%). Only 34.3% had used SDF clinically. The mean OKS was 5.31 ± 2.69 / 10 (moderate level); 35.5% correctly identified the recommended 38% concentration, while 52.4% did not know it. Attitudes were broadly favourable for coronal caries arrest (non-cavitated: 71.9%; enamel-cavitated: 70.3%), but declined for deeper lesions. The primary barriers were tooth discoloration (56.6%), patient satisfaction concerns (53.6%), and parental acceptance (52.2%). University type was the only significant demographic predictor of SDF use: private-university graduates were significantly more likely to have used SDF than governmental-university graduates (54.3% vs. 30.9%; χ² = 15.674, p < 0.001). SDF users demonstrated significantly higher OKS compared to non-users (mean 6.45 ± 2.04 vs. 4.72 ± 2.80; p < 0.001). Two-thirds (66.2%) anticipated increasing future SDF use. Libyan dentists demonstrate moderate awareness but suboptimal pharmacological knowledge and clinical adoption of SDF. Deficits are uniform across all demographic subgroups, indicating a systemic educational gap that requires coordinated curriculum reform and targeted continuing professional development. The use of SDF among Libyan dentists is still limited and has not yet become established in routine clinical practice. In Libya, it is necessary to increase training on SDF, primarily through the university, to promote its wider use and increase its use, especially as a non-invasive caries treatment.

Key Words: Schwartz-Jampel syndrome, Botulinum toxin A, Myotonia, Mentalis muscle overactivity, Case report.